Inspection on 05/05/05 for Riverside Close, 8

This inspection was carried out on 5th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Riverside Close, 8 30/06/06

Riverside Close, 8 08/12/05

Riverside Close, 8 08/02/05

Riverside Close, 8 01/07/04

Riverside Close, 8 18/03/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 8 Riverside Close Bootle Liverpool Merseyside L20 4QG Lead Inspector Debbie Corcoran Unannounced 5th May 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 8 Riverside Close F53 F03 S5240 Riverside Close V230796 050505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service 8 Riverside Close Address 8 Riverside Close Bootle Liverpool Merseyside L20 4QG 0151 944 2716 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Autism Initiatives Mr Paul Binks Care Home 3 Category(ies) of Learning Disability (3) registration, with number of places 8 Riverside Close F53 F03 S5240 Riverside Close V230796 050505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Service users to include up to 3 LD Date of last inspection 8.02.2005 Brief Description of the Service: 8 Riverside Close is a small home registered for three people with a learning disability. The service is provided by Autism Initiatives and the registered Landlord for the propery is Riverside Housing Association. Autism Initiatives was formerly called the Liverpool and Lancashire Autistic Society and it was established in 1971. The organisation provides a variety of services to adults and children who have autism. These include residential care, day care, supported tenancies, outreach, domiciliary care, respite and educational services. Autism Initiatives is a voluntary organisation with charitable status. 8 Riverside Close is a four bedroom house which is located in a residential area in Seaforth, Merseyside. The home has good transport links. There are two staff available to support the service users throughout the day and a sleep in member of staff. The home is a domestic property which promotes the principles of ordinary community living. 8 Riverside Close F53 F03 S5240 Riverside Close V230796 050505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Inspection was unannounced and took place over 5.5 hours. During the visit both of the service users were spoken with to obtain their views on the home and all of the staff were spoken with either on an informal group basis or on a one to one basis. A tour of the home was carried out. This didn’t include the service user’s bedrooms on this occasion. What the service does well: What has improved since the last inspection? At the time of the previous inspection the manager had left and a member of the care staff team had recently become acting manager. This person was not receiving the necessary support to manage the home effectively. A significant number of requirements and recommendations were made following the last inspection and 11 of the 17 of the requirements given have now been met. The requirements given included a review and update of the service user’s plans, an update of all health related records, a review of risk assessments, ensuring that adequate quantities and variety of food was maintained safely and 8 Riverside Close F53 F03 S5240 Riverside Close V230796 050505 Stage 4.doc Version 1.30 Page 6 hygienically and medication administration records to be maintained accurately. One of the service users confirmed that there have been improvements since the previous inspection particularly regarding food and both service users appeared more relaxed. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 8 Riverside Close F53 F03 S5240 Riverside Close V230796 050505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection 8 Riverside Close F53 F03 S5240 Riverside Close V230796 050505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 5 The home has a statement of purpose and service user guide to provide service users and their representatives with information on the home. Systems are in place for assessing the needs of prospective service users, arranging introductory visits and a trial stay. Each of the service users has a contract with the home. EVIDENCE: A statement of purpose which describes the services offered by the home in some detail is available. The statement of purpose was examined and needs to be updated to reflect changes at the home. A guide for service users which describes the services offered by the home is also in place. This should also be produced in formats suitable to the needs of the service users. For example providing the information on compact disc or video tape. There is currently a vacancy for a service users at the home. A number of members of the staff team have visited a prospective service user in order to build up a knowledge of the persons needs and determine the appropriateness of the home in meeting their needs. An assessment of the prospective service users needs has been carried out by a social worker and this information has been provided to the staff team. A more detailed assessment which is specific to the person’s needs in relation to autism is to be carried out by a suitably experienced member of staff from Autism Initiatives. 8 Riverside Close F53 F03 S5240 Riverside Close V230796 050505 Stage 4.doc Version 1.30 Page 9 It was evident from discussions with members of the staff team that staff do not seem to be fully aware of the planning involved in the new service user’s potential placement. Information should be shared with relevant people including the service users as appropriate. Service users have a written contract / statement of terms and conditions between themselves and the home. These contracts are signed by the service users and relevant others such as staff, representatives of the service users and manager of the home. A senior manager from Autism Initiatives visited the home during the inspection and reported that the prospective service user will have opportunities to visit the home prior to deciding whether or not to move in and the process will be flexible and planned around the needs of the individual and the current service users living at the home. 8 Riverside Close F53 F03 S5240 Riverside Close V230796 050505 Stage 4.doc Version 1.30 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9, Service users contribute to their care plans and are involved in the reviewing of these and are consulted on aspects of their daily lives. Service users are supported by staff to be involved in activities which have an element of risk but these are managed and well documented. EVIDENCE: Each of the service users have a care plan and these have recently been updated. The service user have written some of the information in their file themselves. Service users have a review of their support needs every six months. The reviews involve a meeting with the service user, members of their family or other representatives eg social worker. Both of the service users are overdue a review of this kind and one of the service users said that they would like a review in the near future. The team leader reported that a date has been fixed for a review for one of the service users. Risk assessments are in place for each of the service users and cover different aspects of their support. For example support with communication, keeping safe, managing medication. The risk assessments include a good level of information on what the potential risk is and what steps need to be taken to prevent the risk from occurring. The risk assessments have recently been 8 Riverside Close F53 F03 S5240 Riverside Close V230796 050505 Stage 4.doc Version 1.30 Page 11 reviewed and updated. When observing the interaction and conversations between service users and staff it appears that the service users are encouraged to make choices regularly. Staff have a good level of awareness of the needs of the service users in processing information and therefore an awareness of when it is appropriate to limit options or choices in line with the needs of the service users. There is written information which confirms that one of the service users has been offered particular choices and has declined these. 8 Riverside Close F53 F03 S5240 Riverside Close V230796 050505 Stage 4.doc Version 1.30 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 16, The home works on the principle of ordinary community living and the service users are supported by staff to use local facilities and join in activities of their choice. The service users are encouraged and supported to develop their independent living skills and develop both socially and emotionally. EVIDENCE: Service users were seen to approach the staff for advise on a number of occasions. The relationships between the service users and staff appears to be based on mutual respect. Each of the service users has a plan of care and these contain a good level of information on the strengths and needs of the service user. Plans include goals for personal development which give the service users and staff targets to aim for. Discussion with members of the staff team indicated they are aware of the needs of the service users and offer them support appropriately. The staff are focused on supporting the service users to do things independently. The service users were seen to be carrying out household tasks during the day. The 8 Riverside Close F53 F03 S5240 Riverside Close V230796 050505 Stage 4.doc Version 1.30 Page 13 service users are supported by staff to manage their own money and medication when appropriate. This was confirmed during conversation with the service users and an examination of records supported this. Service users are included in day to day decisions making within the home as witnessed during conversations between service users and staff and confirmed during conversation with service users. There is no evidence that service users are involved in wider decisions making such as being involved in the recruitment and selection of staff or development of policies or procedures. The service users know the local community and go to a local pub, shops and restaurants and use public transport regularly. Service users said that they were happy with the level of social activities which they are involved in. 8 Riverside Close F53 F03 S5240 Riverside Close V230796 050505 Stage 4.doc Version 1.30 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20 Service users are encouraged and supported to use their independence in personal support. Service users are supported to remain healthy and their choice in attending appointments is respected. Medication is handled safely in accordance with policies and procedures. EVIDENCE: Staff have written guidelines as to how to support the service users with personal support. Staff are aware of these guidelines and are therefore clear as to what each of the service users needs and routines are and the service users benefit from consistency of support. Service user’s plans include written guidelines on how to support the individual with their emotional needs. Staff are therefore able to understand the emotional needs of the service users and support them appropriately. A record of all health appointments and the outcome of these is maintained. These are supposed to be reviewed six monthly as part of the service users review of their care. The service users have not had a six monthly review for some time now and there are some gaps in evidencing regular health checks. The delay in reviews is as a direct result of the lack of management at the home. This should now have been resolved as a new manager is in post. A 8 Riverside Close F53 F03 S5240 Riverside Close V230796 050505 Stage 4.doc Version 1.30 Page 15 review for one of the service users has been scheduled to take place. One service users is aware of the delay in their review and has expressed that they would like a review to be arranged. Service users are encouraged to maintain and administer their own medication based upon a risk assessment and risk management. As a safeguard to service users all medication, which is received in to the home or administered, is recorded and a stock check of medication is carried out regularly. Two members of the staff team have received training in the administration of medication. 8 Riverside Close F53 F03 S5240 Riverside Close V230796 050505 Stage 4.doc Version 1.30 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 A complaints procedure is in place but this has not been followed in responding to a complaint made by one of the service users. The complaints procedure has not been effective and has failed to protect the service user. The complaint has not been handled to ensure that the service user is confident that their concerns have been listened to, taken seriously and acted upon. EVIDENCE: There is a complaints procedure at the home. One of the service users is awaiting the outcome of a complaint which he made to the organisation a number of months ago. Staff absence has meant that the service user has not received any information as to whether or not the complaint has been investigated and the outcome of the investigation. There is no evidence therefore that the complaints procedure has been followed in this case. The service user should be informed of the outcome of his complaint. The home has policies and procedures aimed at the prevention of abuse and responding to allegations of abuse. The home has written guidelines as to support the service users with emotional issues and protecting service users from placing themselves at harm. These guidelines are good. One of the service users said that they were encouraged to manage their own money. The home has a policy and procedure on the management of service user’s money, valuables and financial affairs and a representative from Autism Initiatives carries out financial audits at the home. 8 Riverside Close F53 F03 S5240 Riverside Close V230796 050505 Stage 4.doc Version 1.30 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, The home is generally well presented, comfortable, homely and safe. However, there is room for improvement in the decoration of some areas. Service users bedrooms are small and don’t allow for many personal belongings but they do promote the service users independence and privacy. EVIDENCE: The home is in keeping with others in the area and is an ordinary domestic property. The house is bright and homely. The home has a lounge and dining room and therefore service users have use of a private room if they so wish. The dining room needs to be redecorated and could be used more effectively if the furniture was changed and the tumble dryer moved to a more appropriate place. Members of the staff team have carried out some decorating in the home. Whilst this is admirable it is not the most appropriate use of staff time, particularly as the task does not involve the service users. A tour of the home revealed that a number of other areas require attention; • The kitchen cupboards are in need of replacement. These are not well repaired / matched. • Rubbish should be removed from the garden • The dining furniture needs to be replaced 8 Riverside Close F53 F03 S5240 Riverside Close V230796 050505 Stage 4.doc Version 1.30 Page 18 • Downstairs w.c is in need of some redecoration. Records of fire and health and safety checks were looked at and found to be up to date with the exception of the fire alarm which should be tested more frequently, this was discussed with the manager. Water temperatures are regulated. This was tested in the bathroom and was close to 43 c thus ensuring the service users are not at risk from scalding. Service user’s bedrooms are small and therefore do not allow for too many personal belongings or furniture. The service users have their own possessions in their rooms. The rooms are lockable and service users also have a lockable storage space. 8 Riverside Close F53 F03 S5240 Riverside Close V230796 050505 Stage 4.doc Version 1.30 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35, 36 Service users are supported by members of staff who have a good level of understanding of their needs. The amount of use of agency staff to cover staff vacancies is concerning and is having an adverse effect on the well being of one of the service users. EVIDENCE: There are two members of staff available at all times to support the three people who use the service. There is a good level of one to one support available to service users. Records confirmed that two staff are on rota to work at all times. The level of use of agency staff continues to present a challenge to the service users. The service users need as much consistency as possible in the staff team and whilst there are vacant posts this can lead to uncertainty for the service users and means that they can be being supported by people who do not have an appropriate level of knowledge and understanding of their needs. This affects the quality of service provided at the home. Service users need as much consistency as possible in the staff team and one of the service users said they would like to see the staff vacancies filled. The registered person should ensure that attempts to fill the staff vacancies are made as a matter of priority. 8 Riverside Close F53 F03 S5240 Riverside Close V230796 050505 Stage 4.doc Version 1.30 Page 20 Staff are not receiving formal recorded supervision. The manager is waiting to receive training in supervision of staff and when completed he will then provide supervision to members of the staff team. A senior manager of Autism Initiatives is intending to provide supervision to staff in the interim. Staff have received training in health and safety related skills and in issues which relate more specifically to the needs of the service users, for example communicating with people who have autism. This means that the service users benefit from being supported by staff who have a good level of understanding of their needs. * One member of temporary staff has been made a permanent member of staff since the time of the inspection. This has therefore reduced the number of vacant staff hours and the service users are reported to be pleased with the appointment. 8 Riverside Close F53 F03 S5240 Riverside Close V230796 050505 Stage 4.doc Version 1.30 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38, 39, 42 The appointment of a manager has resulted in an improvement in standards since the previous inspection. The service users are now benefiting from the leadership and direction of the staff team. Practices to ensure the health, safety and welfare of service users and staff are undertaken. EVIDENCE: The manager has not made an application to register with the Commission. This must be addressed as a matter of priority. An application for registration of a manager has been made a requirement following previous inspections but remains outstanding. One of the service users needs to feel confident that there is stability and consistency in the management arrangements at the home and the process of registration of the manager should not be delayed any further. A number of policies and procedures are in place which aim to ensure the health and safety of service users and staff and these include policies on health and safety, infection control, fire safety and moving and handling. 8 Riverside Close F53 F03 S5240 Riverside Close V230796 050505 Stage 4.doc Version 1.30 Page 22 Fire safety and health and safety practices are adopted. Records of fire and health and safety checks were checked and found to be up to date with the exception of the fire alarm which should be tested more frequently, this was discussed with the manager. Water temperatures are regulated. The temperature of the water was tested in the bathroom and was close to 43 c thus ensuring the service users are not at risk from scalding. The registered person should ensure that the home is visited on an unannounced basis at least once per month and provide a report on the findings of the visit to the Commission in line with Regulation 26 of the Care Home Regulations 2001. These visits should form part of the quality assurance process and should involve seeking the views of service users (and their representatives as appropriate) and staff in order to form an opinion on the standard of care provided. 8 Riverside Close F53 F03 S5240 Riverside Close V230796 050505 Stage 4.doc Version 1.30 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 x x 3 Standard No 22 23 ENVIRONMENT Score 1 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 2 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 x x x x Standard No 11 12 13 14 15 16 17 3 3 3 x x 3 x Standard No 31 32 33 34 35 36 Score x 3 2 x 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 8 Riverside Close Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x 2 2 x x 3 x F53 F03 S5240 Riverside Close V230796 050505 Stage 4.doc Version 1.30 Page 24 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA 37 Regulation 8 Requirement Timescale for action Immediate 2. 3. 4. YA 36 YA 33 YA 22 18 (2) 18 (1) (b) 22 (3) 5. YA 39 26 (5) 6. 7. YA 42 YA 24 23 (4) (v) 23 (2) The registered person must ensure that an application for the registration of the manager is made to the Commission. Staff must be provided with regular and recorded supervision. (a) The registered person must ensure that vacant posts are appointed to. (4) The registered person must ensure that any complaint made under the complaints procedure is fully investigated and the person who has made the complaint must be informed of the action (if any) that is to be taken. The registered person shall ensure that the home is visited at least once per month on an unannounced basis and shall supply a copy of the report following the visit to the Commission. (c ) Fire alarm tests must be carried out at appropriate intervals. (d) The dining room and downstairs w.c must be redecorated. Household debris must be removed from the garden. 4.07.05 8.08.05 Immediate 4.07.05 Immediate 5.09.05 8 Riverside Close F53 F03 S5240 Riverside Close V230796 050505 Stage 4.doc Version 1.30 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA 24 YA 24 Good Practice Recommendations The kitchen cupboards should be replaced. Dining furniture should be replaced. 8 Riverside Close F53 F03 S5240 Riverside Close V230796 050505 Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection 2nd Floor Burlington House Crosby Road North Waterloo L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 8 Riverside Close F53 F03 S5240 Riverside Close V230796 050505 Stage 4.doc Version 1.30 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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